CVS MED D
What work instruction can you use to assist with questions regarding the Automatic Refill Program?
What is Compass MED D- Automatic Refill Program (ARP) 061907
What date needs to be reviewed prior to submitting a cancellation of enrollment request? Part 2, what WI did you find the answer in?
What is the Benefit Effective Date
Part 2. Compass MED D - Cancellation of Enrollment 062814
During a phone call, Jordan asks if Expressed Consent notifications can be sent via text message. Can Jordan receive Expressed Consent notifications via text?
What is Yes.
Who handles eligibility for the SSi EGWP State of Delaware?
What are the 5 Ws which must be included on every call?
What is Who, What, Where, When and Why.
What is within 14 calendar days.
What action should you take if a beneficiary asks to split the cost of an order across more than two methods of payment?
What is Contact the Senior Team for assistance.
What is a Prescription Drug Plan (PDP)?
What is a standalone plan that covers only prescritpion drugs?
What should a CCR always do first before attempting to fulfill a beneficiary's request for literature.
What is Refer to the CIF
What should be the first thing you do when responding to a Coverage Determination call?
What is Refer to the Client Information Form (CIF) to determine who handles Coverage Determinations for the plan.
How should you always respond to a caller who asks a general question about Medicare benefits?
What is Yes, I can help you!
Who is eligible to enroll in Medicare?
What are People 65 years or older.
Younger individuals with disabilities
Individuals with end-stage renal disease.
Christine Chavez is calling to inquire about the status of their Med D enrollment. After logging into FAZAL, what do you do next?
What is On the FAZAL Home screen, place the cursor over the Search And Reports hyperlink until the drop-down menu appears.
When is the Annual Enrollment Period (AEP) for all Medicare D beneficiaries?
When is October 15th - December 7th
When a beneficiary wants to change their permanent home address, where is the update made?
What is Updates are made in both the Medicare D Landing Page tab using the RxEnroll Care system AND the Member Snapshot Landing Page.
A beneficiary enrolls in a Part D plan on Oct. 19th during the Annual Enrollment Period (AEP). What is the effective date for the plan?
What is January 1st of the following year?
Where can you verify who handles filing a Grievance for a beneficiary?
What is Check the CIF to verify who handles the Grievance. If the Grievance is handled by the client, follow the instructions within the CIF.
You access a beneficiary's account. Upon review of the Claims landing page in Compass, you notice that the prescription for Lipitor has not been transferred from the previous PBM.
What is the next step to take?
What is Create a Support Task?
What System must be used to confirm LIS Status?
What is use Marx?
When will a newly enrolled beneficiary typically receive their plans first Premium invoice?
What is Within 45 days of their enrollment effective date.
Sue Alvarez has a prescription for a Tier 1 medication. It costs $40. There's $20 remaining in the deductible phase before Sue meets their $545 deductible. The copay in the ICL is $10 for Tier 1 medications.
What is Sue's copay?
What is$30?
You are assisting a Medicare Part D beneficiary who received a COB letter. The caller says, "I need to update my coverage, but I don't remember what coverage I have." What should you do?
What is Advise the beneficiary to contact the Medicare Benefits Coordination & Recovery Center at 1-855-798-2627, from 8 a.m. to 8 p.m., Eastern Time, Monday-Friday except holidays.
Karen Mills calls stating they received a letter saying that they may be disenrolled from their Medicare plan due to non-payment of the premiums. Karen was in the hospital and was unable to pay at the time. Karen would like to know what they can do to have their prescription drug coverage reinstated.
What work instruction should you access to help Karen?
What is Compass - Aetna Med D SilverScript - Process for Good Cause Determinations - For Non-payment of Plan Premiums Compass - Aetna MED D - EGWP & SilverScript - Premium Billing Invoice Requests
Lyle Lynn calls Customer Care. Upon their call being answered, they say:
"I recently found out my prescriptions would be cheaper if I switched to Mail Order. I am unsure how to do that. Can you help me get started using my Mail Order benefits?" Is this an Inquiry, a Resolved Grievance, or a Not Resolved Grievance?
Is this an Inquiry, a Resolved Grievance, or a Not Resolved Grievance?
What is This call could become a Resolved Grievance if Lyle were to become dissatisfied with their Mail Order benefits when the CCR educates them on how to use Mail Order.
Imagine that you receive a call from Bob, a Pharmacy Technician at Rite Start Pharmacy. Bob processed a claim for a beneficiary, Abbie Vines, for Cozaar on 01/5/2024, but Abbie never picked the medication up. Today is 03/15/2024 and you are attempting to reverse the claim, but the system will not let the claim reverse due to the amount of time that has passed.
How should you respond in this scenario and which Work Instruction should you access to assist the beneficiary?
What is Warm transfer to the Senior Team for assistance.
Compass - Reverse Transmission CCR Process 050134